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Helping individuals with firearm injuries: A cluster randomized trial
Vivian H Lyons1, Anthony S Floyd, Elizabeth Griffin
1From the Department of Health Behavior and Health Education (V.H.L.), University of Michigan, Ann Arbor, Michigan; Department of Epidemiology (V.H.L., E.G., A.H., F.P.R., A.R.-R.), School of Public Health, Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center (V.H.L., A.S.F., J.W., L.K.W., K.P.H., F.P.R., A.R.-R.), Alcohol and Drug Abuse Institute (A.S.F.), and Department of Biostatistics (M.C.), University of Washington, Seattle, Washington; Department of Biostatistics and Bioinformatics (D.B.), Emory University, Atlanta, Georgia; Department of Emergency Medicine (L.K.W.), School of Social Work (K.P.H.), Social Development Research Group (K.P.H.), and Department of Pediatrics (F.P.R.), School of Medicine, University of Washington, Seattle, Washington.
Background:
Patients with firearm injuries are at high risk of subsequent arrest and injury following hospital discharge. We sought to evaluate the effect of a 6-month joint hospital- and community-based low-intensity intervention on risk of arrest and injury among patients with firearm injuries.
Methods:
We conducted a cluster randomized controlled trial, enrolling patients with firearm injuries who received treatment at Harborview Medical Center, the level 1 trauma center in Seattle, Washington, were 18 years or older at the time of injury, spoke English, were able to provide consent and a method of contact, and lived in one of the five study counties. The intervention consisted of hospital-based motivational interviewing, followed by a 6-month community-based intervention, and multiagency support. The primary outcome was the risk of subsequent arrest. The main secondary outcome was the risk of death or subsequent injury requiring treatment in the emergency department or hospitalization.
Results:
Neither assignment to or engagement with the intervention, defined as having at least 1 contact point with the support specialist, was associated with risk of arrest at 2 years post-hospital discharge (relative risk for intervention assignment, 1.15; 95% confidence interval, 0.90-1.48; relative risk for intervention engagement, 1.07; 95% confidence interval, 0.74-2.19). There was similarly no association observed for subsequent injury.
Conclusions:
This study represents one of the first randomized controlled trials of a joint hospital- and community-based intervention delivered exclusively among patients with firearm injuries. The intervention was not associated with changes in risk of arrest or injury, a finding most likely due to the low intensity of the program.
Level Of Evidence:
Care management, level II.
